Provider Demographics
NPI:1326210071
Name:LUCAS, LAYLA CORRAL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAYLA
Middle Name:CORRAL
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAYLA
Other - Middle Name:MARIE
Other - Last Name:CORRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6442 E SPEEDWAY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-0012
Mailing Address - Country:US
Mailing Address - Phone:520-777-4090
Mailing Address - Fax:520-332-2941
Practice Address - Street 1:6442 E SPEEDWAY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1134
Practice Address - Country:US
Practice Address - Phone:520-777-4090
Practice Address - Fax:520-318-3061
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80921208600000X
AZ42608208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ208600000XOtherAZ